HEALTH COVER
THAT PUTS
YOU FIRST
July 2016
1
NOT-FOR-PROFIT MEANS INVESTING IN YOUR HEALTH NOW, AND FOR THE FUTURE
YOUR HEALTH
COMES FIRST
BECAUSE WE'RE
NOT FOR PROFIT
We’ve been putting our members' health first since 1932,
using our not-for-profit status to provide cover and
support so you can lead a healthier, happier life.
MORE CENTS IN
EVERY DOLLAR
HCF RESEARCH
FOUNDATION
On average over the
last 5 years HCF has
paid out more cents
in every dollar in
premiums to members
as benefits, than the
industry average
Funding important
health and medical
research to improve
the quality of
healthcare for all
Australians
AVOID OUT-OF-POCKET
HOSPITAL COSTS
Our big participating hospital
network means that the majority
of members having hospital
services will experience either
no gap, or minimise their costs
significantly compared to going
to a non-participating hospital
OVER
35,000
SPECIALIST DOCTORS
participate in the HCF Medical Gap
cover scheme, helping you to pay less
MY GLOBAL SPECIALIST
Three easy ways to contact us
CALL US 13 13 34
VISIT A branch
GO TO hcf.com.au
Mon - Fri 8am - 8pm AEST
Sat - Sun 9am - 5pm AEST
An award-winning local call centre, 50+ branches nationwide and great online resources.
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When you need a
second opinion, get
the best advice from a
global network of over
50,000 medical experts.
Available on selected
levels of cover
?
100% BACK
on selected services like dental check-ups,
optical and initial consults through over
10,000 participating More for You service
providers.
This is subject to your level of cover and
annual limits
VICTOR CHANG
CARDIAC
RESEARCH
INSTITUTE
Access free heart
health checks through
our partnership with
this world-leading
organisation
MY HEALTH
GUARDIAN
Since inception
members with chronic
conditions using this
program have shown
a 46% improvement
in managing their
medication
CHOOSE
THE COVER
THAT’S BEST
FOR YOU
WANT
AMBULANCE
ONLY COVER?
Visit
hcf.com.au/
ambulance
You can create your own hospital and extras package by selecting one of the
hospital covers below and adding your preferred extras option. Or if you only
want a hospital cover or just need extras, you can do that too.
CHOOSE YOUR HOSPITAL COVER
BASIC
Basic hospital cover
designed for the healthy
& budget conscious.
MID
Affordable hospital
cover for some
common procedures.
• No excess for
accidents
• No excess for
accidents
• No excess for kids
• No excess for kids
• Digestive disorder
procedures and more.
• Heart surgery, joint
investigations & more
• Free access to a great
range of health and
wellbeing programs.
MID PLUS
Comprehensive
hospital cover
for those not requiring
cover for pregnancy.
PREMIUM
Premium hospital
cover for those who
prefer complete
peace of mind.
• No excess for
accidents
• No excess for
accidents
• No excess for kids
• No excess for kids
• Heart and joint
replacement surgery
& more
• Only one excess for
same day hospital
admissions
• Free access to a
great range of health
and wellbeing
programs.
• Pregnancy, heart
surgery, joint
replacement surgery
& more
• Free access to a great
range of health and
wellbeing programs.
& OR CHOOSE YOUR EXTRAS COVER
BRONZE
BRONZE PLUS
SILVER PLUS
Cost effective,
entry-level extras
cover that’s
competitively
priced.
Basic extras cover
for dental, optical
and selected
therapies.
Affordable mid
level extras
cover for a range
of services and
therapies.
• Basic extras
cover for dental
and selected
therapies.
• A step up from
Bronze extras,
with higher
limits plus
optical benefits
At participating
providers and
subject to your
annual limits you
get:
• 100% back on
1 dental check
per year.
Not available
in NT & Tas.
At participating
providers and
subject to your
annual limits you
get:
• 100% back on
up to 2 dental
checks per year.
Not available
in NT & Tas.
GOLD
Quality extras
cover for a wide
range of services
and therapies.
At participating
providers and
subject to your
annual limits you
get:
• 100% back on
2 dental checks
per year.
Not available
in NT & Tas.
PLATINUM
Top level extras
with the highest
coverage for
therapies and
services.
At participating
providers and
subject to your
annual limits you
get:
• 100% back on
2 dental checks
per year.
Not available
in NT & Tas.
• 100% back on
an initial physio, • 100% back on
• 100% back on
chiro, osteo,
certain spectacles
an initial physio,
podiatry consult*
and lenses and
chiro, osteo,
FREE digital
podiatry consult*
• 100% back on
retinal imaging
certain spectacles • 100% back on
eye check.
and lenses and
certain spectacles
FREE digital
and lenses and
retinal imaging
FREE digital
eye check.
retinal imaging
eye check.
* One initial consult for new health conditions or flare ups where no treatment has been provided
in the previous 3 months.
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5
SUGGESTED PACKAGES
TO SUIT YOUR NEEDS
We’ve created a selection of hospital and extras packages
to make choosing a cover easier.
WHICH BEST SUITS YOU?
YOUNG SINGLES
& COUPLES
PLANNING
A FAMILY
FAMILY
WITH KIDS
NO
PREGNANCY
TOP COVER
JUST HOSPITAL
OR EXTRAS COVER
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SUGGESTED HOSPITAL & EXTRAS
Basic Hospital
Bronze Plus Extras
Young Starter Package
Mid Hospital
Silver Plus Extras
Premium Hospital
Silver Plus Extras
Premium Hospital
Gold Extras
Premium Hospital
Platinum Extras
Basic Hospital
Silver Plus Extras
Mid Hospital
Gold Extras
Premium Hospital
Platinum Extras
Mid Hospital
Silver Plus Extras
Mid Plus Hospital
Gold Extras
Mid Plus Hospital
Platinum Extras
Premium Hospital
Silver Plus Extras
Premium Hospital
Gold Extras
Premium Hospital
Platinum Extras
Choose Hospital or Extras cover on its own.
And if you take out Hospital cover only and
want to add Extras later (or vice versa) it’s
easy to add it on when you’re ready.
YOUNG STARTER
PACKAGE
Designed for young singles
& couples getting health cover
for the first time
• Can save you tax if you’re
a high income earner
• 100% back on up to 2 dental
checks per year. At participating
providers and subject to your
annual limits. Not available in
NT & Tas
• 100% back on certain spectacles
and lenses and FREE digital
retinal imaging eye check
• Young Starter includes hospital
and extras cover
• FREE overseas travel insurance
for anyone on your policy.
Visit hcf.com.au/bonustravel or
calling 13 13 34 to find out more.
HCF has obtained overseas travel insurance cover (Cover)
under a master policy issued by AIG Australia Limited ABN 93
004 727 753, AFSL 381 686. This Cover is available while you
remain a Premium Hospital, Mid Plus Hospital (when combined
with Silver, Gold or Platinum Extras), or Young Starter policy
holder, subject to our right to remove or alter the Cover on 30
days notice. The terms, conditions and Excluded Services of the
Cover are specified in the ‘Conditions of Use’ (available at
hcf.com.au/bonus travel) as amended, and must be reviewed
to make sure that the Cover meets your needs.
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HOSPITAL BENEFITS
SUMMARY
WAITING PERIODS
YOUNG STARTER
PACKAGE
BASIC
MID
MID PLUS
PREMIUM
$250 or $500
$250 or $500
$250 or $500
Nil or $250 or $500
Singles & Couples only
Choose your excess (per person per calendar year)
No excess for kids
$250 or $500
HOSPITAL
Palliative care
Psychiatric services
Pre-existing ailments or conditions
NA
No excess for accident related treatment
Pregnancy & birth related services
For same day hospital admissions, pay only one excess
per policy, per year
All other hospital services
Available as hospital cover only (without extras)
Yes
Yes
Yes
Yes
Includes accommodation, operating theatre, intensive care, Government approved prostheses, pharmaceuticals and physiotherapy, as part of your covered admission at a participating private hospital
Removal of tonsils, adenoids, appendix
Surgical treatment of a hernia
Removal of kidney stones & gall stones
Digestive disorder procedures (e.g. bowel surgery)
Cancer related services (e.g. chemotherapy)
Heart surgery including diagnostic & therapeutic cardiac procedures
Spinal surgery (excluding surgery related to spinal scoliosis)
Surgery related to spinal scoliosis
Cochlear implant surgery & bone anchored hearing devices*
Insulin pump treatments†
Care involving dialysis for chronic renal failure
Rehabilitation services
Psychiatric services
Gastric banding & obesity surgery
Emergency ambulance
(where not for pre-existing ailments)
Pre-existing ailments
#
Accident related treatment after joining
(except for Excluded Services on your policy)
Joint investigations & reconstructions
Joint replacements (e.g. hip replacements, knee replacements)
Cataract & other lens related surgery
Sterilisation and sterilisation reversals
Podiatric surgery by an accredited podiatrist
All other in-hospital services where a Medicare benefit is payable
2 months
1 day
12 months
Waiting periods vary according to the type of treatment
or service. Go to hcf.com.au for more information.
MINIMUM BENEFITS
If you choose a hospital cover where Minimum Benefits
apply to some procedures then HCF will pay the rate set
out by the Commonwealth Minister for Health, from time
to time, as the Minimum Benefit paid for a shared room and
benefits for Government approved Prostheses List items.
In a private hospital: These benefits wouldn’t cover all the
hospital costs and there could be significant out-of-pocket
expenses for you to pay.
In a public hospital: If you elect to be a private patient in a
public hospital, you may have to pay out-of-pocket expenses
if these benefits are less than what your chosen public
hospital charges or do not cover all hospital costs.
EXCLUDED SERVICES
If you choose a hospital cover where some procedures are
excluded then nil benefits apply for the episode of care.
If multiple procedures are provided in a single episode of
care and one procedure is excluded then nil benefits apply
for the entire episode of care.
In a private hospital: You are responsible for all hospital
charges and could have significant out-of-pocket
expenses.
In a public hospital: If you elect to be a private patient in a
public hospital, you are responsible for all hospital charges
and could have significant out-of-pocket expenses.
Assisted reproductive services (e.g. IVF, GIFT)
Pregnancy & birth related services
12 months
AMBULANCE
No
(Available with Young
Starter extras only)
Examples of what’s covered
Emergency Ambulance
2 months
Rehabilitation services
#
*
†
Covered
Minimum Benefits
Excluded Services
Excluding experimental and high-cost non-PBS drugs. See page 21 for more information.
Includes associated speech and sound processors including upgrades.
Certified type C procedures and certified overnight type C procedures for the treatment of diabetes. Reduced or no
benefits may apply.
See hcf.com.au/insulinpumps for details.
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EXTRAS BENEFITS
SUMMARY
CATEGORY
SERVICE
YOUNG STARTER
PACKAGE
WAITING
PERIODS
GENERAL DENTAL
MAJOR DENTAL
Diagnostic &
Preventative
Application of fluoride
Fillings - direct
Tooth extractions
Fillings - indirect
Oral surgery
Periodontics
Endodontics
Crowns & Bridges
Dentures
Orthodontics
OPTICAL
Removal of plaque/calculus
LIMITS
Glasses &
Contact lenses
$500
2 months
Direct fillings (1-2 surfaces)
Direct fillings (3 or more surfaces)
Simple extractions
Indirect fillings
Surgical extractions
Treatment of tissue surrounding teeth
Treatment of root canals
Preparation and/or placing of crowns
and bridges
Dentures and/or components (partial
and complete). Limits renew every 3 years
BRONZE PLUS
SILVER PLUS
Max 2 check ups,
2 scale and clean,
and 1 fluoride
treatment
per person, per year
LIMITS
LIMITS
$350 per person
Max $700 per policy
$400 per person
Max $800 per
policy
Max 1 check up,
1 scale and clean,
and 1 fluoride treatment
per person, per year
Max 1 check up,
1 scale and clean,
and 1 fluoride
treatment
per person, per year
LIMITS
2 months
$100 per person
Max $200
per policy
$150
$200
$100 per person
Max $200
per policy
$120 per person
Max $240
per policy
$180
$250
THERAPIES
Occupational therapy
Psychology (after Medicare
entitlement used up)
Acupuncture and/or Chinese herbal
medicine consultation
Naturopathy and/or nutrition
consultation
2 months
(12 months
for foot
orthotics)
$150
Combined with
physiotherapy limit
$80 per person
Max $160 per
policy
$150
Dietetics/Audiology/Speech pathology
OTHER
Artificial aids
Hearing aids
Health Management
Programs
No annual limit
Max 2 check ups,
2 scale and clean, and
1 fluoride treatment
per person, per year
BACK ON
EXTRAS
HCF approved after PBS equivalent co-pay 2 months
HCF approved (e.g. low vision aids,
12 months
blood glucose monitors)
Benefits accrue over time and renew
24 months
every 5 years
HCF approved (e.g. exercise classes,
6 months
weight management)
$100
$100
ON HCF EXTRAS
COVER
At participating
providers, subject
to your cover and
annual limits.
To find out more, visit
hcf.com.au/100back
Dental check-ups through
HCF's More for Teeth providers.
Not available in NT and Tas
Eyewear and free digital
retinal imaging eye check through
HCF's More for Eyes providers
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6+
$600
$650
$700
$800
$900
$1,000
Year 1 $900
Year 2 $950
Year 3 $1,000
Year 4 $1,100
Year 5 $1,200
Year 6+ $1,300
$200
$250
Year 1 $300
Year 2 $325
Year 3 $350
Year 4 $400
Year 5 $450
Year 6+ $500
Year 1 $500
Year 2 $550
Year 3 $600
Year 4 $700
Year 5 $800
Year 6+ $900
Year 1 $200
Year 2 $225
Year 3 $250
Year 4 $300
Year 5 $350
Year 6+ $400
Year 1 $250
Year 2 $275
Year 3 $300
Year 4 $350
Year 5 $400
Year 6+ $500
Sub-limit $200
Sub-limit $200
per therapy service
per therapy service
(except for chiro and osteo) (except or chiro and osteo)
Podiatry (including foot orthotics)
Note: foot orthotics annual limit is capped at
Year 1
Vaccines & Immunisations
No annual limit
Max 2 check ups,
2 scale and clean, and
1 fluoride treatment
per person, per year
$700 ($350 for other $800 ($400 for other
dentists)
dentists)
Lifetime limit $2,100 or Lifetime limit $2,400 or
$1,050 for other dentists $1,200 for other dentists
Exercise physiology (group and/or classes
covered under Health Management)
Remedial massage and/or myotherapy
LIMITS
An initial physio, chiro and osteo
consultation through HCF's
More for Muscles and More for
Backs providers
An initial podiatry consultation
through HCF's More for Feet
providers
12 months
Physiotherapy (group and/or classes
covered under Health Management)
Initial/Subsequent
LIMITS
100%
$500
Max 2 check ups,
2 scale and clean,
and 1 fluoride
treatment
per person,
per year
Contact lenses - pair
Chiropractic/Osteopathy
PLATINUM
GET
Orthodontics - Orthodontist
/ non-orthodontist
Spectacle frames
Spectacle lenses - pair
GOLD
Annual limits, per person, per calendar year, unless otherwise specified (set benefits apply per service item)
Examinations
Single film x-rays - initial/subsequent
(on same day)
BRONZE
Year 1 $200
Year 2 $225
Year 3 $250
Year 4 $300
Year 5 $350
Year 6+ $400
Year 1 $250
Year 2 $275
Year 3 $300
Year 4 $350
Year 5 $400
Year 6+ $500
$180
$280
Max. $150 per policy Max. $200 per policy
$600 - $1,600
$800 - $1,800
$50 per person
$150 per person
$200 per person
Max $100 per policy Max $300 per policy Max $400 per policy
Not covered
WAITING PERIODS
EXTRAS
Health Management
Programs
Crowns and Bridges
Dental bleaching
Dentures
Endodontics
Foot orthotics
Indirect fillings
Occlusal therapy
Oral surgery
Orthodontics
Periodontics
Pre-existing ailments
& conditions
Prosthodontics
Veneers
Artificial appliances
(e.g. low vision aids, blood
glucose monitors)
6 months
12 months
12-24
months
Hearing aids
24 months
All other extras services
2 months
FINANCIAL PROTECTION
WHEN YOU NEED IT MOST
If something happened to you, would you and your family cope financially?
We offer a range of low-cost options to help you with cash you can use
however you want.
KIDS’ ACCIDENT
COVER
BOUNCEBACK
COVER
INCOME ASSIST
INSURANCE
PERSONAL ACCIDENT
INSURANCE
Pays a lump sum if your child (under 17)
is accidentally injured
Protection for young people against
common accidents and illnesses
Pays a monthly benefit if you can’t
work due to sickness or injury
Pays a lump sum for certain injuries
and accidental death
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Receive up to $100,000 cover
Only 90 cents per week per child
Cover 24 hours a day, Australia-wide
Paid regardless of any other benefits
CASH BACK
COVER
Protect you or your family in the event
of illness and accidents
Receive up to $100,000 cover
$1 per day
Cash paid directly to you
Make multiple claims up to a max
of $100,000
• Generous payments for illnesses like
tonsillitis and appendicitis
CRITICAL ILLNESS
COVER
Provides extra cash for certain illnesses
or accidents
Receive up to $6,000 per month
From $1.65 per week
75% of your income for up to 12 months
Cover against accident and illness
Additional benefits paid for child care
expenses and bed confinement
• Premiums may be tax deductible
• Protection for your biggest asset your income
SMART TERM
INSURANCE
Protects your loved ones financially
if something happens to you
•
•
•
•
Receive up to $5,000
$2 per week for singles
$4 per week for families
Cover for illnesses such as heart attack,
cancer and stroke
• Make multiple claims up to $20,000 for
singles and $40,000 for families
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•
•
•
•
•
Receive up to $50,000 cover
From $2.50 per week
Choice of $25,000 or $50,000 cover
Lump sum cash benefit
Cover for serious illnesses like heart
attack, cancer and stroke. 90 day
waiting period applies
• Single and family cover options
•
•
•
•
Receive up to $500,000 cover
From $3.45 per week
Benefit doubled for death by accident
Includes early payment of $10,000 to cover
funeral expenses for death by accident
in the first 3 years and thereafter for all
conditions
• Easy to apply - no blood tests or medicals
Receive up to $50,000 cover
From $3.15 per week
Choice of $25,000 or $50,000 cover
Lump sum cash benefit
Especially designed for those aged
55 years and over
For more information on these products,
visit hcf.com.au/life-insurance
Please consider each Product Disclosure
Statement available and your financial situation,
objectives and needs before deciding on these
products as the information provided does not
take these into account.
Call 13 13 34 or visit hcf.com.au/life-insurance
for details.
The Cash Assist covers are issued by our own HCF Life Insurance
Company Pty Ltd. ABN 37 001 831 250, AFSL 236 806.
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HEALTH MANAGEMENT PROGRAMS
On eligible extras covers, you can claim on a
range of HCF approved Health Management
Programs to help you lead a fit and healthy life.
Programs include:
• Weight management
• Exercise classes and gym membership fees
for specific health conditions
(doctor’s referral required)
• Childbirth education
• Lactation consultant
• Learn to swim.
HEALTH AND
WELLBEING PROGRAMS
TO HELP YOU GET THE
MOST OUT OF LIFE
DOWNLOAD HEALTHY APPS
Get fitter
Build your fitness and become more
flexible, with routines for all levels.
Be happier
Improve your emotional wellbeing, and
better manage life's stressful times.
Quit smoking
Will help you on your journey and
make it just a bit easier to quit smoking.
Fit&Well magazine
Access the latest health and lifestyle
insights to empower you make the
best choices for your health.
14
SUPPORTING YOU TO HAVE A
HEALTHIER AND HAPPIER LIFE
My Health Guardian features online tools that
help you manage your diet, health and fitness.
It is provided at no cost to members 18 years
and over with hospital or extras cover.
Take the virtual tour at hcf.com.au/mhg
You can also use the Well-Being Plus
app as part of the My Health Guardian
program, to track your progress and
set goals.
Available for Apple and Android.
Download at hcf.com.au/mobile-apps
A six month waiting period and conditions apply
to claims for Health Management Programs.
WEIGHT MANAGEMENT
FOR CHRONIC CONDITIONS
Our Healthy Weight For Life programs help
improve your quality of life if you have Type
2 Diabetes, Cardiovascular conditions or
Osteoarthritis.
For more information visit hcf.com.au/hwfl
WANT A SECOND OPINION?
Available on eligible covers My Global Specialist
gives you access to world-leading medical
specialists to review your case.
For more information visit hcf.com.au/mgs
or call us on 13 13 34.
Visit hcf.com.au/healthmanagement for more.
MEMBER OFFERS
FREE OVERSEAS TRAVEL
INSURANCE ALREADY INCLUDED
WITH PREMIUM HOSPITAL,
MID PLUS HOSPITAL WITH
GOLD OR PLATINUM EXTRAS
OR YOUNG STARTER PACKAGE
10% OFF HCF
TRAVEL & PET INSURANCE*
Conditions apply.
Visit hcf.com.au/travel or
hcf.com.au/petinsurance for more.
This insurance is issued by AIG – see details
on page 7 or at hcf.com.au/bonustravel
10% OFF MORE AT HOME
A community care service providing
in-home support and personal care.
Available in Sydney.
To find out more, visit moreathome.com.au
or call 1300 550 124.
More at Home is owned by Manchester
Unity, a subsidiary of HCF.
10% OFF NEW 3 AND 12
MONTH MEMBERSHIPS
WHEN YOU JOIN
A once-off admin fee applies.
Visit hcf.com.au/fitnessfirst to find out more.
* HCF Travel Insurance and Pet Insurance are respectively issued by QBE Insurance (Australia) Limited ABN 78 003 191 035
AFSL 239545 and The Hollard Insurance Company Pty Ltd ABN 78 090 584 473 AFSL 241 43. HCF Travel / Pet Insurance is
not part of HCF’s health insurance business. Consider the PDS at hcf.com.au/travel and hcf.com.au/petinsurance before
making any decisions about these products.
IMPORTANT THINGS
YOU NEED TO KNOW
ABOUT HEALTH COVER
Information to help you make the right choice, pay lower premiums
and avoid unnecessary costs.
REBATES, SURCHARGES
AND INCENTIVES
Changes to private health legislation
can affect your choice of health cover,
so understanding how to get your
maximum entitlements and avoid
unnecessary expenses makes sense.
AUSTRALIAN GOVERNMENT REBATE
ON PRIVATE HEALTH INSURANCE
To help make private health cover more affordable,
the Australian Government provides a rebate
on your health insurance premium. The rebate
is available to people with hospital, extras or
ambulance cover, and who are registered with
Medicare. The rebate is income tested, so your
entitlement may change depending on your
income and your age.
You can take the rebate as:
• A reduced premium
OR
• A tax offset credit in your annual tax return.
When calculating your income be sure to include
taxable income, fringe benefits, reportable
superannuation contributions, net financial
investment losses and more. You may have to
pay additional tax if you nominate an incorrect
rebate tier.
We can provide you with general information
on these thresholds, for personal advice specific
to your circumstances you should consult your
accountant, financial advisor or the ATO at
ato.gov.au or 13 28 65.
See privatehealth.gov.au/healthinsurance/
incentivessurcharges for the list of rebate
percentages.
MEDICARE LEVY SURCHARGE
The Medicare Levy Surcharge is an Australian
Government initiative designed to encourage
high-income earners to be responsible for their
health care. It only applies if you will earn above
this year's income threshold and don’t have eligible
private hospital cover.
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You can avoid paying this by having eligible
HCF hospital cover. If you don’t have eligible
private hospital cover and fall into these income
thresholds, you’ll be charged an additional
surcharge on your Medicare levy when your
tax return is assessed.
To view this year's income thresholds and
Medicare Levy Surcharge information,
go to privatehealth.gov.au/healthinsurance/
incentivessurcharges
LIFETIME HEALTH COVER
Lifetime Health Cover (LHC) is a Government
initiative that encourages people to take out
hospital insurance earlier in life, and maintain
their cover.
In some cases, you may be exempt or fit into a
special circumstances category. If you don’t have
hospital cover with an Australian registered health
fund on 1 July following your 31st birthday, and
then decide to take out hospital cover later in life,
you’ll pay a 2% loading on top of your premium, for
every year you are aged over 30.
For example, if you take out hospital cover at age
40 you’ll pay 20% more than someone who first
took out hospital cover at age 30.
The maximum loading is 70%. Once you have paid
a LHC loading for 10 continuous years, the loading
is removed as long as you retain your hospital
cover.
For members who have switched from another
fund, if your LHC loading differs to what was listed
in the transfer certificate, your premiums may
change accordingly.
The Australian Government Rebate does not apply
to the LHC component of private health insurance.
This means if you are eligible for the rebate and
also have a LHC loading, the rebate won’t apply to
the LHC portion of your health insurance.
To find out if you need to pay the LHC loading,
you can use the Lifetime Health Cover calculators
at privatehealth.gov.au (and search for Lifetime
Health Cover).
For more information, visit hcf.com.au
or call us on 13 13 34.
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THINGS YOU NEED TO KNOW
ABOUT HEALTH COVER
PRE-EXISTING AILMENTS OR CONDITIONS
WHAT’S NOT COVERED
A pre-existing ailment, illness or condition is one
where the signs or symptoms existed during the
six months before joining HCF (or upgrading to
a higher level of cover), even though a diagnosis
may not have been made. If there’s any doubt
that an ailment or condition is pre-existing, an
HCF-appointed medical practitioner will examine
information provided by your doctor, and any other
relevant claim details.
There are a number of situations where our
health insurance doesn’t cover you:
• If a Service is listed as an excluded service
(regardless of whether required as a result of an
Accident) in the Product Information (as defined
in the Fund Rules);
• Claims made 2 years or more after date of
Service;
• Elective Cosmetic Surgery;
• When a Member has the right to recover
the costs from a third party other than HCF,
including an authority, another insurer or under
an employee benefit scheme;
• Treatment for Pre-Existing Conditions (other
than for psychiatric rehabilitation or palliative
care) within the 12 month Waiting Period
(the Pre-Existing Condition Waiting Period
applies to new Members and Members
upgrading their Policy to any higher level
Benefits under their New Policy);
• Services received during any period where
payment is in arrears, the Policy is not financial,
the Policy is suspended or within a Waiting
Period;
• Treatment that HCF deems to be inappropriate
or not reasonable, after receiving independent
medical or clinical advice;
• Any Service where the Treatment does not meet
the standards in the Private Health Insurance
(Accreditation) Rules;
• Emergency room fees;
• Services that are not delivered face to face, such
as online or telephone consultations, unless a
Member is participating in a Chronic Disease
Management Program or Health Management
Program;
• Services supplied by a provider not recognised
by HCF;
• Services provided outside Australia which do not
meet the requirements under the Private Health
Insurance Act; or
• Ambulance transfers between hospitals
(emergency or non-emergency)
• Claims that do not meet HCF’s criteria as set out
in the Fund Rules.
WHO CAN BE COVERED?
Prior to taking out health insurance, you should
understand who can be covered under your policy.
You can find out more by visiting hcf.com.au/faqs,
and searching for ‘Who does my membership cover?’
HOSPITAL COVER FOR IN-PATIENT
SERVICES
Hospital benefits are payable when you’re
admitted to hospital for treatment. These are
called ‘in-patient’ services, and only in-patient
services are covered by your hospital cover.
HCF PARTICIPATING PRIVATE HOSPITALS
HCF has negotiated agreements with private
hospitals in all states and territories, which covers
approximately 95% of all HCF admissions to
private hospitals. The agreements limit hospital gap
charges that apply to the health cover you have,
like your excess option.
For a full list of participating private hospitals,
visit hcf.com.au/participatinghospitals
Please note: this list is subject to change.
HCF Non-participating Private Hospitals
We only pay a Minimum Benefit towards
accommodation and prostheses. You may have to
pay out-of-pocket expenses for accommodation,
theatre, labour ward fees and prostheses.
Public Hospitals
We pay a Minimum Benefit for a shared room, and a
higher rate for a single private room. You will need to
confirm with the hospital if they will be charging you
any out-of-pocket expenses.
IN ADDITION, OUR HOSPITAL COVER
DOESN’T INCLUDE:
IN ADDITION, OUR EXTRAS COVER
DOESN’T INCLUDE:
• H
ospital Benefits (including medical Benefits)
for Excluded Services or for Services in respect of
which the claim is not approved for payment by
Medicare;
• Experimental treatment;
• Experimental, high cost non-PBS Drugs and TGA
approved Drugs used for a purpose other than
that for which they were approved;
• Procedures normally performed in the doctor’s
surgery or as an outpatient;
• Private room accommodation for same-day
procedures;
• Respite care;
• Benefits for Nursing Home Type Patients except
as determined under the Minimum Benefits
requirements of the Private Health Insurance Act;
• Special nursing;
• Luxury room surcharge;
• Donated blood and blood products;
• Donated blood collection and storage;
• PBS pharmaceutical benefits in private
Non-Participating Hospitals;
• Pharmaceuticals (including PBS pharmaceuticals
benefits) and other sundry supplies not directly
associated with the reason for admission;
• Take home items including crutches,
toothbrushes and drugs;
• Personal convenience items including the cost of
phone calls, newspapers, magazines and beauty
salon services;
• Massage and aromatherapy services;
• Select Services provided while in Hospital by
non-hospital providers;
• Benefits where a Service is an Excluded Service
for the payment of Benefits in a Hospital, and
any other Services including medical, diagnostic,
Prosthesis and pharmacy received at the same
time; and
• The gap on government approved gap-permitted
Prostheses items.
• P
sychological and developmental assessments;
• Co-payments and gaps for government funded
health services including the co-payment for
PBS items;
• Psychology treatment (where included under
a Policy) unless a mental health plan has been
prescribed under Medicare entitlements and
these entitlements have been exhausted for the
calendar year;
• Services while a Hospital patient except for
eligible oral surgery;
• Pharmacy items that are not on HCF’s approved
pharmacy list including items listed on the
PBS, items prescribed without an illness, items
that are available without a prescription, items
supplied by a Hospital as take home drugs, or
items that are not approved by the TGA;
• Services that had not been provided at time
of claim;
• Fees for completing claim forms and/or reports;
• Services received overseas or purchased from
overseas including items sourced over the
internet;
• Where no specific health condition is being
treated or in the absence of symptoms, illness
or injury;
• Routine health checks, screening and mass
immunisations;
• More than one therapy Service performed by
the same provider in any one day;
• Where a provider is not in an independent
Private Practice; or
• Where more than one Service of physiotherapy,
chiropractic and osteopathy therapies is received
on the same day.
Please note: Our list of approved pharmacy items,
artificial aids and appliances, participating hospitals
and no gap providers are subject to change and
updated regularly. If your cover includes any of
these items and you wish to make a claim, please
call us on 13 13 34 to confirm your benefits.
19
EMERGENCY AMBULANCE
(EXTRAS ONLY)
For NSW or ACT residents with standalone extras
cover, there is unlimited emergency ambulance
cover for transport within NSW or the ACT.
For emergency transport received outside of NSW
or the ACT, there is an annual limit of 1 service per
person and 2 per policy.
Residents of Queensland are covered Australia-wide
under their state ambulance service scheme and no
Benefits for ambulance services are payable by HCF.
Residents of Tasmania are covered across Australia
under their state ambulance service scheme,
excluding in Queensland and South Australia.
You may claim under your HCF cover for services
in these states, with an annual limit of 1 service
per person and 2 per policy.
For residents in Vic, SA, NT and WA, if you don’t
have an ambulance subscription with your state
ambulance service, you may claim under your HCF
cover with an annual limit of 1 service per person
and 2 per policy.
In all instances, Benefits are only claimable from
HCF when you aren’t otherwise covered for
emergency ambulance services e.g. through state
ambulance arrangements, pensioner or social
security entitlements. Services must be provided
by a state Ambulance Service Provider. See the
Member Guide for details.
20
Please Note
This is not a comprehensive list of items that aren’t
covered under hospital or extras cover. Please call
13 13 34 to check what you’re covered for prior to
going to hospital or for treatment.
This brochure should be read in conjunction with the
HCF Member Guide, a copy of which is available at
hcf.com.au or at HCF branches.
CHANGES TO PRODUCTS AND PRICING
Please read and retain this brochure for future
reference. We reserve the right to make changes to
prices, product specifications and other conditions
relating to the products contained in this brochure.
Please contact us before purchasing any products
to make sure that you have the latest information
available.
HOW YOUR RIGHTS
ARE PROTECTED
PRIVATE HEALTH INSURANCE
CODE OF CONDUCT
The Private Health Insurance (PHI)
Code of Conduct’s aim is to improve
the standards of practice and service
in the private health insurance industry.
We support this by ensuring you:
• receive correct information about
private health insurance
• are aware of the internal and external
dispute resolution procedures
• can make an informed decision about
your purchase
• you’re protected in accordance with
the privacy principles.
For a full copy of the code, visit
privatehealth.com.au/codeofconduct
HAVE A COMPLAINT?
If there's a problem with your membership or cover,
please contact HCF directly so we can assist in
resolving it as quickly as possible.
OMBUDSMAN
If your complaint isn’t dealt with satisfactorily,
you can also contact the relevant Ombudsman
- independent bodies formed to help resolve
complaints and provide advice and information.
If your complaint is about Health Insurance:
Private Health Insurance Ombudsman
Call: 1300 362 072
Visit: ombudsman.gov.au
Email: phio.info@ombudsman.gov.au
Online: ombudsman.gov.au/making-a-
complaint/contact-us
Write: Private Health Insurance Ombudsman,
Commonwealth Ombudsman,
GPO Box 442, Canberra, ACT, 2601
If your complaint is about Life Insurance,
Pet Insurance or Travel Insurance:
Financial Ombudsman Service Australia
Call: 1300 367 287
Visit: fos.org.au
Email: info@fos.org.au
Write: Financial Ombudsman Service Limited,
GPO Box 3, Melbourne, VIC, 3001
21
OUR PRIVACY STATEMENT
HCF is committed to best practice
privacy protection.
We collect your personal information including
sensitive information such as health information
from you and/or the Policyholder who is
responsible for your policy and/or from other
third parties detailed in our Privacy Policy,
so we can:
•
•
•
•
•
•
•
•
•
•
Comply with applicable laws
Manage our relationship with you
Record your treatment
Provide health or other insurance, related
products and services to you (including
through third parties)
Manage and pay claims and benefits
Assess your insurance, health and related
lifestyle needs
Investigate fraudulent or improper claims
and assess risks
Research and develop products, services and
benefits that may better serve your needs
Assess your possible interest in, and tell
you about such products and services
Administer our business and deal with
complaints.
We may share or disclose your personal information
to third parties or individuals, some of which may be
located overseas, including:
• to the policyholder, if you are a dependant or
another member (e.g. partner or children)
on the policy, for the purposes of your HCF
membership. Our contract with the policyholder
requires us to have full and free communication
with the policyholder on all aspects of the policy,
including the benefits claimed by any member
under the policy;
• to organisations that deliver services on our
behalf or to us, such as third parties that we
contract to assess or process claims, administer
programs that we develop for the benefit of
members, research companies contracted by us
(to ask your opinions on improving the Group’s
service, benefits or product offerings) and
mailing houses;
22
• other service providers, for example, our
advisors;
• between companies within the HCF group of
companies;
• fraud prevention agencies, government bodies
and regulators including law enforcement
bodies such as the Police, professional
associations and industry bodies;
• health service providers (where it is used to
improve their ability to provide you with health
services);
• other insurers or reinsurers including other
health insurers where you have moved your
insurance to or from HCF; and
• where disclosure is otherwise authorised or
required by or under an Australian law or court/
tribunal order.
We do not normally give personal information about
you to anyone who is not on your membership.
You will need to give us written permission if
you want someone who is not covered by your
membership, such as a friend or carer, to deal with
us on your behalf.
If you do not provide the personal information we
request, we may not be able to provide you with our
products or services, including health insurance.
You can ask us at any time to stop direct marketing
to you by calling 13 13 34 or by logging onto the
member section at hcf.com.au/members and
updating your preferences.
For more information about the personal
information we collect and how we handle it,
how to access and correct your information or
to make a complaint and how we will respond
to complaints, please read our Privacy Policy.
To view the HCF Privacy Policy:
• Visit hcf.com.au/privacy
• Visit your local branch.
All new Policyholders should ensure that
all members on the policy are made aware
of the HCF Privacy Policy.
All information in this brochure was correct at the time of printing.
From providing
high quality
healthcare to
helping you navigate
the ever-changing
health system,
we’ll be at your
side wherever
life’s journey leads
23
START ENJOYING
THE BENEFITS ONLY
HCF CAN OFFER
JOIN TODAY
SWITCHING TO HCF IS EASY
To switch, all you need to do is:
1. Choose or create the HCF cover
that’s right for you
2.Call, visit a branch or go online
to complete your application
3.Leave the rest to us.
The Hospitals Contribution Fund of Australia Limited.
ABN 68 000 026 746 ASFL 241 414 MAY16_VAL0123_MG
Head Office: 403 George Street, Sydney NSW 2000
CALL US
13 13 34
Mon - Fri 8am - 8pm AEST
Sat - Sun 9am - 5pm AEST
VISIT A
branch
GO TO
hcf.com.au
DOWNLOAD
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